Thoughts from the interface of science, religion, law and culture

After spending several years touring the country as a stand up comedian, Ed Brayton tired of explaining his jokes to small groups of dazed illiterates and turned to writing as the most common outlet for the voices in his head. He has appeared on the Rachel Maddow Show and the Thom Hartmann Show, and is almost certain that he is the only person ever to make fun of Chuck Norris on C-SPAN.

EVENTS

The ACA and the ‘Gay Agenda’

The Worldnetdaily has a new series of articles written by Jerome Corsi that makes the dog-whistle argument that the Obama administration is using the Affordable Care Act to help those dirty people with AIDS (HIV, actually; most do not progress to AIDS these days if they’re on medication). It starts with this bizarre note from the editor:

EDITOR’S NOTE: This is the first article in the series on the Obama administration’s campaign to enroll lesbian, gay, bisexual and transgender citizens in Obamacare, which force private insurers to cover the high-risk population by distributing the burden to other citizens and away from government.

Wait, the Obama administration is trying to shift the burden of medical care for gay people from the government to private insurance? Wouldn’t a conservative think that’s a good thing? Of course, the overwhelming majority of gay people are not getting their medical care from the government anyway, but why let a little thing like a fact get in the way of a perfectly good dog whistle rant?

The Obama administration’s emphasis on enrolling the LGBT community in Obamacare strongly suggests it has an unspoken agenda of shifting to healthy citizens the extraordinary financial burden of providing services to the unique demographic, which is afflicted disproportionately by AIDS and other health issues.

Are they? Yes, gay men have a higher rate of HIV infection, but gay women have a lower rate than straight people. You never hear the bigots mention this when they’re making an argument based on relative health problems. And of course, this is the entire point of insurance, that you combine sick people and healthy people into a single market and the economics works out so that the insurance company makes a profit even though people with more health problems cost more than those who are healthy. That principle is no different for gay people than it is for straight people and no different for those with HIV than those with diabetes, cancer or anything else.

In effect, by eliminating health underwriting, Obamacare has transformed health insurance for the LGBT into a “guaranteed-issue,” even if the applicant has HIV/AIDS.

Right. Which is equally true of every single American with any preexisting medical condition. But apparently this suddenly matters when it comes to gay people. And remember that Corsi’s position, and that of the Worldnetdaily, is that insurance companies should be able to deny or drop coverage for anyone if they get sick — which is the only reason to have health insurance in the first place. Which means they are forced to rely on government insurance (Medicaid, mostly) or be treated without the ability to pay, which means distributing the burden either to other people or the government (which is, of course, the same thing).

A conservative should be all for this if they actually care about not shifting the burden of health care to the government or other people in the health care market. If what they really want is to let people die if they get sick, on the other hand, they would be taking exactly the position they are.

Comments

A conservative should be all for this if they actually care about not shifting the burden of health care to the government or other people in the health care market. If what they really want is to let people die if they get sick, on the other hand, they would be taking exactly the position they are.

This is essentially the same argument that got Alan Grayson into political trouble. Except that he also considered the fact that the GOP wasn’t offering any alternative plans to improve health care results when making the same conclusion Ed makes here.

So Grayson’s argument was on firmer ground, yet his rhetorical bomb-throwing hurt him while that rhetorical approach frequently helps conservative politicians. That says something about the mindset of people attracted to conservatives and to those attracted to liberals.

It’s just creepy how WND can thrive by creating “stories” and assumes its readers have no awareness of reality whatsoever. Folks with no context, no facts, no knowledge, no curiosity, just a gullible gaping maw to pour the bullshit into.

Skiers also have a higher injury rate than non-skiers, and skiing is a choice… so they’re on their own. Also, car drivers have a higher rate of getting in car accidents than non-car drivers, and that’s a choice too.

Setting aside the idea that they think homosexuality is bad (I give zero fucks what their book has to say about this), almost no one could be on insurance, because if we were filtering out people who did risky things that were by choice, there’d be almost no one left who is eligible.

I kinda thought the point of things like health insurance was so that the people can live their lives without having to worry about having a safety net in place.

Of course. They think women should be punished for having sex by being forced to bear children until they die from it, and that gay people should be punished for having sex by stoning. Since that’s not allowed, AIDS will have to do. Can’t let medical insurance get in the way of either of these God-willed results.

I thought that conservatives would understand the iron rule of economics: “There ain’t no such thing as a free lunch.”

Even if we stopped Medicaid benefits for HIV treatment, we, as a society, would then have to decide how to care for the people who are then dying of AIDS because we didn’t treat their HIV. Treating Kaposi’s sarcoma and the other opportunistic diseases that AIDS sufferers get is much more expensive than treating HIV. Even if we stopped Medicaid benefits for treating opportunistic diseases that AIDS sufferers get (talk about your “death panels”!) then what do we do about all the other social effects of dying people out on the street? Remember when Saint Ronnie kicked out all the mentally ill people out onto the streets and the “quality of life” in our big cities went to hell and all the corporations were leaving for more humane places?

But, of course, Farah, Corsi and the rest aren’t really “conservatives.” They are wingnuts who want to turn the US into some nightmareish authoritarian state where their, and only their, sense of dog-eat-dog “morality” prevails.

Of all the arguments against the ACA, the one that ticks me off the most is this “I shouldn’t have to pay for health care for [group of people] or [disease] or [condition] or [medical procedure]!”

Some men complain that their policies now cover ob-gyn procedures. Some straight people complain that their policies cover gay people. Etc., etc.

But that is how insurance works, and THAT IS HOW HEALTH INSURANCE HAS WORKED FOREVER, long long long before the ACA was even dreamed of. When I was childless, my policy covered ob-gyn expenses. When I was pregnant and needed those services, I used them. Now 20 years later, my policy STILL covers those expenses, though I am past childbearing age and will never need them again!! My policy covered my husband’s heart surgeries, though I did not need those services!

It’s the whole fucking point of insurance!

Really, there’s nothing that ticks me off more than willful ignorance.

And I fault Obama et al. for not educating the public on this simple point: Health insurance has ALWAYS worked this way. The difference now is that the details of your policy are easier for you to see.

GRR.

I admit to being in a foul mood because the NY Times continues to publish essays by Christian apologist TR Luhrmann, and I just made the mistake of reading the latest installment. I posted a “what is this crap?” comment – waiting to see if it makes it past the moderators.

Remember when Saint Ronnie kicked out all the mentally ill people out onto the streets and the “quality of life” in our big cities went to hell and all the corporations were leaving for more humane places?

The degradation of U.S. cities pre-dates President Reagan’s presidential tenure. I’ve also never encountered any research that finds cities were degrading was due to a change in the 1980s on how we treat, or fail to treat, the mentally ill. If you’re aware of such research I’d be happy to consider it.

In addition, I’d be very skeptical that corporations left city centers because of mentally ill homeless people. I’m also confident that even if this was a factor, it’s such a weak one it doesn’t bear up being presented as the only reason they left.

Of all the arguments against the ACA, the one that ticks me off the most is this “I shouldn’t have to pay for health care for [group of people] or [disease] or [condition] or [medical procedure]!”

Some men complain that their policies now cover ob-gyn procedures. Some straight people complain that their policies cover gay people. Etc., etc.

But that is how insurance works, and THAT IS HOW HEALTH INSURANCE HAS WORKED FOREVER, long long long before the ACA was even dreamed of.

You’re correct the argument you refer to is essentially idiotic as its presented here by Jeromi Corsi. However your apparently taking it to the other extreme is not necessarily prudent policy.

For example, should the government force insurance providers to allow smokers pay the same premiums that non-smokers pay? Should the government force insurance providers to allow smokers to sign up in the same group plan as non-smokers?

These are worthy questions attempting to reach a laudable result. And that’s to minimize negative external costs and instead push those costs back onto the producers and consumers who create these costs. Doing so can reduce the overall total cost of a good and service which benefits nearly everyone.

While not taking a position on the above example, I use very similar thinking to argue that men should pay premiums that helps cover health-care unique to women; and that’s not because I think it’s a fair way for insurance providers to spread risk, it’s probably not. But instead because I think it’s sound public policy just like I think it’s sound public policy to figure out how to minimize or eradicate negative external costs.

Nonetheless, shared risk and shared expense is the basis for insurance. And too many people are ignorant of that fact, and ignorant of the fact that they have been sharing risk and sharing expense for as long as they have participated.

Sorry, guys, I just don’t have time to read the OP or the other comments but I gotta axe; what is the American Clown Associations problem with teh GAY? I mean they both dress up in weird clothes and wear lots of make-up AND kids are scared shitless of THEM, too. Is it some “turf” thing or professional jealousy or what?

Just when you think they can’t get more evil, they do. There is so much wrong with Jerome Corsi and his perversion of xianity, I don’t even know where to start.

1. Not all HIV+ are gay. Worldwide, the large majority are heterosexuals, of those most are women and children.

2. In the USA, IIRC it is around 1/3 heterosexual HIV+ and slowly shifting to the world norm.

3. Of of the largest groups of US HIV+ are the poor. Increasingly, HIV+ is condition of poor people. And since it is a social problem of poverty, it is increasingly in…fundieland, the south. We would be way better off if the treated the underlying causes of a lot of social problems, fundie xianity and fundieland.

4. A lot of the HAART (AIDS drugs) patients are already covered by Medicaid so the ACA won’t make any difference.

5. It makes huge economic sense for the government to hand out HAART so that everyone who needs it, gets it. It’s much cheaper to keep people healthy then pay for long, drawn out end stage AIDS. HAART also drives down the HIV virus to low levels, and cuts the transmission rate by an astounding 90%.

In computer models, universal HAART would come close to driving the HIV virus out of the human population.

6. What’s Corsi’s solution, let people get sick and die? I’m sure that is exactly what he wants. Who would jesus kill? First anyway. When xian became synonymous with wannabe mass murderer, some people didn’t want to be one any more.

I’m reminded of an anti-vaxxer troll who said that if someone’s kid died of a disease their unvaccinated kid transmitted, they deserved to die for not being healthy enough. It sounds like the same admiration of natural selection’s ability to pick out who’s “worthy” of living. It leaves me to wonder if congress would be voting on eugenics bills today if Hitler didn’t make the topic unpopular. Given how Hitler is becoming an increasingly generic bad guy as memories fade, I won’t be surprised if people forget the association and return to proposing eugenics programs.

The whole idea of dropping people from insurance for getting sick also sounds like the usual wingnut love of parasitism. If the insurance company isn’t willing to face the risk that their customer might get very sick or very injured and pay for treatments, what exactly are they doing to earn the customer’s money? The whole idea is that several individuals who fear the health risks involved in, you know, living agree to pay a company to manage those risks collectively. The company still makes a profit because there are more than enough people who stay relatively healthy and pay their premiums into old age to offset the costs of those who aren’t so lucky. (Thanks in large part to good doctors who sell ounces of prevention before the insurance company is obligated to buy pounds of cure or tons of palliatives.) In exchange, the insured get peace of mind knowing that if they get some expensive illness or injury, the insurance company will pay for it.

If the insurance companies aren’t expected to uphold their end of the bargain, how are they making a positive contribution to the economy? If they won’t give us that peace of mind, why should we pay them? If they’re allowed to cherry pick whose risks they take on, how can any paying customer be confident they won’t be next one dropped when they get a big medical bill? Wingnuttia has a con artist culture running it. They want their corporate allies to make a profit with no effort and no risk. Let the buyer beware, and never the seller. The nasty thing here is that they’re getting potential victims to support them because some ancient pastoral culture’s deity is reputed to have said gay is icky enough to deserve death.

Non-human parasitic organisms are free to complain about the comparison with wingnuts, since their options in life are limited by their biology. As human beings (as much as some of us humans hate acknowledging that common ground), wingnuts presumably have a choice to be benign or harmful. It’s not like evolution overspecialized their digestive systems to process nutrition from tears at the cost of everything else.

Jul 5, 2012 – AIDS is the primary killer of African-Americans ages 19 to 44, and the … “The most recent statistics from the Centers for Disease Control indicate that 45 percent of all the new cases of HIV infection are amongst African-Americans. … in the year 2015, especially in the South, it will probably be the case that 5 …

HIV is becoming an infection of poverty. And that means minorities who are overrepresented in that economic group.

Almost half of all new infections are among Blacks, and mostly in the deep South, Florida, Louisiana, South Carolina etc..

Most of these won’t be on private insurance, they will end up on Medicaid. The ACA doesn’t change anything for this group.

MSM make up less than 5 percent of the population but nearly 50% of cases irrespective of colour.

There is still a big stigma for MSM in black communities and that does lead to a more impressive spread of HIV. And indeed there is a problem of HIV prophylaxis dropping since schools are unwilling to teach safe anal sex alongside safe vaginal sex.

Hence my rule of “no glove? no love!” when it comes down to sex education with that in mind.

There were about 34 million people living with HIV at the end of 2012. This includes the 2.3 million people who were infected with the virus, but not the 1.6 million people who died of HIV related causes. There are about 6,300 new infections every day, an average rate of nearly 262 new infections every hour. Since the first documented reports of AIDS/HIV, more than 75 million people have contracted the disease, and 36 million are known to have died from it (not counting those who died of other causes.)

3.4 million, or 10% of the global total, are children aged 15 or younger; of the remaining 30.6 million, about 15.7 million, or slightly more than half, are women. Since 2006, HIV disease has been the leading cause of death among all women in their reproductive years.

About 70% of all people living with HIV — 23.8 million — live in sub-Saharan Africa. That region represents 75% of all HIV related deaths in 2012. Western and central Europe accounts for about 2.5% of the global total. North America — the United States, Canada and Mexico — has only about 1.4 million people with HIV, slightly more than 4% of the global total.

In North America and western and central Europe, HIV is still largely confined to gay men. Everywhere else in the world, it is overwhelmingly a disease among straight men and women. In the United States, women of color are the fastest growing segment of people with HIV, with straight men of color following close behind.

The fact is that anyone who sees HIV/AIDS as a “gay disease” is extremely uninformed. Or, as I suspect is the case here, willfully ignorant because facts do not agree with bigotry or fundraising goals.

@Avicenna #15 – Geographic location is a very important consideration. There are countries where the HIV prevalence rate is quite high: Swaziland (26%), Botswana (23.4%), Lesotho (23.3%), South Africa (17.3%), Zimbabwe (14.9%), Namibia (13.4%), Zambia (12.5%), Mozambique (11.3%) and Malawi (10%), just to give the hardest hit. That is to say, if you were to randomly pick 100 people in South Africa, chances are that 17 of them would have HIV.

I don’t remember saying that the quality of life issues caused by the large numbers of mentally ill people being dumped on the street was “the only reason” for corporate flight from American cities. There is, however, plenty of evidence that this issue was of great concern in the 1980s and that it was greatly increasing local costs for police, jails, emergency services, etc. At the same time, there is plenty of evidence that American cities were desperately competing to retain or attract corporations that had other global options, mostly by offering tax incentives that aggravated the cities’ revenue situation.

I was talking about the fact that there is no such thing as a free lunch … that everything that we decide to do or don’t do ultimately is paid for (who else?) by us. Do you really think there wasn’t a significant financial cost to our society from dumping the mentally ill on our streets?

Notably missing from Corsi’s analysis is any real numbers for the financial impact of the HIV+ gays on the private insurance companies. Since he is just lying to spread some fear and hate, there won’t be any.

It’s likely to be very minor.

1. Not all HIV+ US, are gays. Around 1/3 are heterosexuals.

2. HIV+ is mostly a condition of poverty. They are and will end up on Medicaid, a government program.

3. Around 25% of HIV+ don’t even know they are infected.

4. It saves a huge amount of money to treat HIV+ with HAART drugs. Lower end stage AIDS, and much lower transmissability. It’s more likely to save money than cost money.

In my area, there isn’t much HIV+. Most of them are IV drug users. The county has a needle exchange program that works. They are very quiet about it to not upset the usuals, right wingnut xians but the people who need to know, know.

During one of the perennial budget crisises, they cut the program. Shortly after, there was a spike in cases, clustered among…IV drug users. This costs the state a lot because they will all end up on HAART someday and most likely Medicaid. The next time there was a budget crisis, they cut a lot. They didn’t cut the needle exchange program.

should the government force insurance providers to allow smokers pay the same premiums that non-smokers pay?

The ACA, in fact, allows insurance companies to charge people who use tobacco 50% more for their premiums (though states get to decide if the carriers can do it). Carriers are, on the other hand, required to cover the cost of “smoking-cessation” treatment.

Should the government force insurance providers to allow smokers to sign up in the same group plan as non-smokers?

Absolutely. Just as they should allow obese people to sign up in the same group plan as thin people but, perhaps, charge them more while covering the cost of weight reduction treatment, including surgery. The “plan” (simply the insurance pool) is intended to “spread the risk,” which is the very idea of insurance. If you break them down into particular sorts of risks, you are defeating the purpose of insurance in the first place.

Don’t you understand? It’s like Hobby Lobby: when I pay to cover other people’s sinful actions I get their sin all over me! Hobby Lobby’s owners are getting sinful ladyparts rubbed all over them, with the ACA we are getting literally covered in gayhomo manparts!

. . . shared risk and shared expense is the basis for insurance. And too many people are ignorant of that fact, and ignorant of the fact that they have been sharing risk and sharing expense for as long as they have participated.

I agree with your premise and I agree too many people are ignorant of the criticality of this premise.

I think there’s three aspects here, people need to understand the utility of insurance and to your fine point, how that utility comes to be. The third aspect is that once we have such a common understanding, that should then drive a public policy debate in how the government regulates insurance policies in a manner that results is optimal outcomes.

Those who suggest no regulation is necessary demonstrate their ignorance in regards to both economics and history. For example, economic profs and their attendant textbooks were using case studies of the health insurance sector to note U.S. market failures as far back as when I was at university, the mid-1980s. The fact their predictions of even worse results came true shows how poor we are at selecting politicians and influencing public policy.

“And of course, this is the entire point of insurance, that you combine sick people and healthy people into a single market and the economics works out so that the insurance company makes a profit even though people with more health problems cost more than those who are healthy. That principle is no different for gay people than it is for straight people and no different for those with HIV than those with diabetes, cancer or anything else.”

In my opinion, the profit-making of the insurance companies is one of the weaknesses of the ACA. In all other countries having a national health care system I’m aware of, I don’t know of any that allow the insurance companies (sickness funds, or whatever) to be for-profit at all. Or, at the very least they forbid them from making a profit on the basic package of care. And for good reason: being for-profit means your interests are fundamentally misaligned with those that you are insuring. More money paid out to cover claims means less profit, and thus you have an incentive to pay out as little as possible.

Probably about 2/3 of BC/BS affiliated insurers are either non-profit or member owned. Kaiser-Permanente is also a big non-profit insurer. In surveys of customers, the non-profits are generally preferred over the for-profit insurers. They aren’t cheaper, but I can attest to the fact that they are much easier to deal with on the provider end, which usually translates into satisfaction on the patient end. I won’t take insurance from a few of the bigger for-profits. As a solo practitioner, it’s just too much of a hassle. I can’t sit on the phone all day talking to idiots whose underlying motive is to find ways to deny claims.

“Those who suggest no regulation is necessary demonstrate their ignorance in regards to both economics and history.”

Either that or (and far more likely, imo) they think poor, sick people deserve to be punished for their sins of being poor and sick.

“More money paid out to cover claims means less profit, and thus you have an incentive to pay out as little as possible.”

Hey, I can see one of those very CARING insurers telling people that they will help them pay for a gym to stay healthy and if you just had a heart attack, instead of giving you medical care, refunding $8.13 a month so you can buy a membership in a shitty health club.